Cyanide is a highly toxic agent which inhibits mitochondrial cytochrome c oxidase, thereby depleting cellular ATP. It contributes to smoke inhalation deaths in fires, and could be used as a weapon of mass destruction. Cyanide is generated in household fires due to the high amount of plastic material that is usually present.
Hydrogen sulfide is an extremely toxic gas for which no treatment is available. Workers in a variety of industries are exposed to hydrogen sulfide—most notably the petroleum industry, where one-third of workers are exposed to sufficient gas to have symptoms, with 8% having experienced loss of consciousness. Moreover, inhalation of hydrogen sulfide gas is a common mode of suicide and the gas could be used by terrorists as a weapon of mass destruction.
Cobinamide has been disclosed as a treatment for cyanide toxicity. In its aqueous state, cobinamide takes the form of aquohydroxocobinamide at neutral pH and is effective when administered intravenously. However, intravenous administration of antidotes is not preferred in mass casualty situations because of the additional skill required to inject intravenously and the time it takes to do such an injection. In a disaster situation, such as a terrorist attack, every second counts and thus a form of cobinamide that can be administered more simply than intravenously is needed.